Effects of Behavioral Therapy on Alzheimer’s

A new study has concluded that behavioral therapy may be more effective in treating symptoms of Alzheimer’s and dementia than the commonly prescribed antipsychotic medication.

Learn more about the study, the benefits of behavioral therapy and the risks of antipsychotic medication for people with Alzheimer’s.

Antipsychotic Medication and Behavioral Therapy for Alzheimer’s

As most Alzheimer’s and dementia caregivers know, the disease is more than just losing memory. Aggressive behaviors, wandering, anxiety and agitation are a few of the symptoms that affect many people with the disease. These symptoms are most commonly treated with antipsychotic drugs. In fact, according to a recent report from the Government Accountability Office, 33% of people with dementia in nursing homes are prescribed antipsychotic medication.

Overall, approximately 14% of people with Alzheimer’s are taking an antipsychotic.

A new study published in the British Medical Journal challenged the widespread use of antipsychotic medication to treat dementia symptoms by concluding that antipsychotics are less effective than non-drug treatments when it comes to managing symptoms of dementia. Researchers observed over 20 years of studies and concluded that Alzheimer’s symptoms were best managed when caregivers were properly trained how to communicate with and engage the person living with dementia.

While acknowledging that medication can be necessary in emergency situations, they found that antipsychotics were about half as effective as behavioral therapy techniques and that their use can have deadly side effects that increases over time.

The United States Food and Drug Administration (FDA) agrees and has issued a warning cautioning that antipsychotics can increase the risk of mortality for people with Alzheimer’s.

Long-Term Use of Antipsychotics More Common in People with Dementia

According to the Finnish Current Care Guidelines, use of antipsychotic medication for people with Alzheimer’s should be a short-term treatment option only for those with severe psychotic symptoms, aggression or agitation. Researchers found that antipsychotic drugs were being used 2-3 years prior to a dementia diagnosis and were most commonly prescribed 6 months following an official diagnosis.

Results were recently published in the British Journal of Psychiatry and concluded that 1/3 of people with Alzheimer’s were using antipsychotics, a rate five times higher than the control group, who did not have the disease. Researchers evaluated over 7,200 people with dementia using antipsychotics and found that 57% of the participants were using the drugs long-term, for over a year.

The researchers also note that the risk of using antipsychotics could do more harm than good in people with Alzheimer’s.

Professor SirpaHartikainen cautions that, “In Finland, the present incidence of antipsychotic use and the duration of antipsychotic treatment are not in line with the treatment guidelines. This is a cause of concern, because the use of antipsychotics increases the risk of severe adverse incidents such as stroke, falling and fracture, and death.”

Behavioral Therapy as a Long-Term Solution for Alzheimer’s

“Why I think the caregiver interventions work is because they train caregivers to look for the triggers of the symptoms. When [caregivers] see the triggers of the symptoms, they train them to manage them… It’s inherently patient- and caregiver-centered.”

She also spoke about the risk of mortality associated with antipsychotic drugs, stating that the risk is small over the short term but increases the longer the drug is used.

The findings lead one to wonder why doctors still prescribing antipsychotic medication to people with dementia. Dr. Kales says she believes that many health care providers are not as familiar with non-drug approaches and those that are, are rarely reimbursed by insurance for non-drug options.

Have you seen the positive effects of behavior therapy on a loved one with Alzheimer’s? What was your experience like? Share your story with us in the comments below.

Please leave your thoughts and comments

peggyutsler

So many nursing homes would rather keep them sedated so as not to be bothered. Please, compassion is so desired, perhaps if you hang pictures of them in their younger days they may be viewed as a person rather then just a job.

ben blue

my wife was given strong Meds as soon as she was told she had Alzheimer’s .she was gat worse .she was a lot better before the strong Meds now she is in stage 6 and some into 7 . I have ben her only caretaker for 7years. I Think the caregiver intervention works very well for I have ben using a lot of triggers of symptoms ,as well as I love you when she gets feisty.and takings for a ride will bring her back. to a better state of mind sort of speak and for a while. I wish I had the good advice before she got so bad .But after 45 years of marriage I God willing I will Keep going as long as I can. thanks for any and all help H L B

nursecathy123cat

Antipsychotics have Black Box warnings of the serious side effects possible for people who take the medication and who have dementia. Another commenter here is correct–it is easier, in the short term, to give a pill and sedate the resident. But spending time and interacting with the person is a better long-term technique. It takes a little more time up front but is both safer and has better results. Owners of long-term care facilities must realize that having enough care staff is essential.

Melyssa A. Harmon

I believe pain is a large contributor to behaviors seen in dementia and memory care residents. Behavioral therapies via trained caregivers, coupled with basic pain management, and the need for psychotropics goes down. Keeping breakthrough pain at bay while providing psychosocial activity as a means of therapeutic intervention speaks volumes to a person living with purpose vs yesteryear sedation. Getting communities to sign on to this is coming around thanks to regulations and innovative health care professionals that understand that it begins with our front line staff.

Judith Wank

Of course, behavioral interventions can be effective and less damaging. But as a retired Alz. Assn. Assistant Director and current support group facilitator, we must also recognize that most caregivers are exhausted, on medications themselves, have financial considerations and strong other physical handicaps themselves. They may not have the emotional resources necessary to even begin to implement behavioral therapies.

My own husband recently died from Parkinson’s. Even with 24 hour live in aide, when psychosis hit, we were unable to manage. I knew I could deal with Parkinson’s, and with dementia if it came, but was unprepared for the challenge of psychosis. And with physical challenges of my own, unable to continue. True for many of my caregivers.

Sometimes, professionals neglect to include the issues of the caregiver which may preclude the ability to handle the time and effort required to utilize behavioral interventions. They are exhausted both physically and emotionally. So despite the risks of pharmaceuticals (consider what caregivers are taking just to survive from day to day), it often becomes the only way to stave off placement of whatever sort is affordable.

Valentin Bragin

The behavioral interventions could be used separately, or in the combination with medications. Medications help to modify patient’s behavior, to regain self-control and to decrease caregiver’s stress. Non verbal communications (posture, touch, tone of voice, facial expression, gestures, and eye contact), and any kind of joint activities (singing, walking, reading, storytelling) increase communications between the patient and caregiver.

Mary

The most effective behavioral intervention I have used and trained my staff on is to treat the residents with the same dignity and respect you would want to be treated with. No “baby talk; no calling residents honey, dear, or sweetheart; acknowledge all the emotions a person experiences; and provide them the opportunity to have a voice in their own lives. People will forget what you say, they will forget what you do, but they never forget the way you make them feel.

caitlinburm

Mary,

Thank you for sharing such incredible insight and advice with us.

About The Author

Alissa Sauer has been dedicated to writing articles about Alzheimer's research and senior living for over 4 years. With a Communications Degree from the University of Illinois, Alissa strives to help families understand and manage the changes that often accompany caring for a senior loved one. On a personal note, Alissa enjoys traveling around the world as a military spouse and spending time with her two young children and Golden Retriever.

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